We agree with Dr. Cianciulli that in order to tackle the managed care "juggernaut," the time for intra-professional division is over and the time for action is now ("Halting the Managed Care Juggernaut: Gate Opening 1997," DC, 12/16/96).But let the record show that the ACA is not now, nor has it ever been, involved in the "blaming" that Dr. Cianciulli cites as a reason managed care is running rampant over the rights of our patients. We've been too busy pursuing an aggressive program to fix managed care to be engaged in the kind of destructive finger pointing to which he alludes.
By developing and implementing a comprehensive strategy to apply uniform national standards of fairness and accountability to managed care and ERISA health plans, the ACA is leading the chiropractic profession, and the health professional community at large, in an effort to ensure that patients come first in this country's health care system.
By now, everyone in the chiropractic profession should be familiar with H.R. 2400, the Family Health Care Fairness Act. This is the bill that ACA helped conceive and draft in 1995 to overhaul the managed care industry. Among the bill's key features are:
- coverage for services by "out-of-network" providers;
- a uniform appeals process for patients and providers to dispute coverage decisions;
- mandatory standards guaranteeing quality, financial solvency and an appropriate number and mix of providers;
- full information disclosure of patient satisfaction, plan performance and covered benefits;
- anti-discrimination requirements to prevent managed care from arbitrarily excluding or dismissing providers based on their type of license.
These and other provisions of the bill would address precisely the concerns that Dr. Cianciulli mentions in his article.
In order to improve prospects for enactment of these concepts, in 1994 the ACA spearheaded the creation of a national coalition of health care provider, consumer and disease specialty organizations known as the Coalition for Health Care Choice and Accountability (CHCCA). Over the last three years, CHCCA has grown to include over 80 national health care groups, has testified before Congress, has organized scores of lobbying visits on Capitol Hill, and has even held press conferences in the nation's capitol to highlight the need to reform managed care.
This leadership started paying off last year, when Congress considered dozens of pro-consumer managed care bills, eventually enacting one to end the outrageous HMO practice of kicking new mothers and their babies out of the hospital 24 hours after delivery. Additionally, Congress came very close to passing an ACA-endorsed bill to prohibit managed care gag rules. A full plate of other "managed care improvement" bills is slated for introduction when Congress reconvenes in January, including H.R. 2400. The ACA is busy developing a strategy with the CHCCA to push these legislative improvements once the new Congress has been sworn in.
The profession simply must rally around these efforts to combat the managed care behemoth before it further erodes our great profession and leaves our patients wanting. Unfortunately, too many in this profession have been slow to respond to ACA's leadership. So far, ACA is the only chiropractic group to come out publicly in support of H.R. 2400 or to join CHCCA.
It is time for the profession to wake up! ACA has been effectively leading the charge against managed care, but with less than half the chiropractic profession as ACA members, this task is much more difficult and taxing than it needs to be. A small and vastly disproportionate share of all DCs are pulling the weight of the entire profession, and if we are to succeed in reforming managed care to address our patients' needs, this simply must change.
We applaud Dr. Cianciulli for correctly highlighting the urgency of this situation. In response, the ACA invites him and all DCs to join us in our ongoing campaign to do something about managed care.
Garrett F. Cuneo
Executive Vice President
American Chiropractic Association
New CPT Codes "Reward Volume Treatment"
The information that has come from the ACA and reprinted in your Dec. 16th issue is sure going to set the profession up for a substantial shock when they finally receive their 1997 Medicare payment and find that the 20% raise may turn out to be a 10% DECREASE.
We can all appreciate the benefits of additional codes over the old A2000, but the automatic increase is not going to be there for many doctors.
In Pennsylvania we have had four Medicare regions assigned by population centers with quite a disproportionate payment schedule. In region four, the lowest group, a chiropractor received $24.44 as a participating provider. The new plan will have two regions, Philadelphia and its surrounding counties and then the rest of the state. In the second region, which will contain most of the practicing chiropractors, the new rate for one or two region adjustments will be $22.77.
The new system, instead of rewarding good diagnostic protocols and careful therapy application, will now reward volume treatment! This is hardly a step forward for our profession.
George Coder, DC
Why Create Our Own Exam?
Logan College of Chiropractic has joined New York Chiropractic College and Western States Chiropractic College in a pilot project, the CCAT (Chiropractic College Assessment Test). The name of the test is obviously patterned after the MCAT, the challenging Medical College Admissions Test. The MCAT, which I took in 1994, is currently used as one of three primary criteria (in addition to academic record and essays) used for determining whether a candidate for medical school will receive an admissions interview. Its stated purpose is to determine how an individual will perform on medical boards, and I am told that it is quite good in this respect.
Unfortunately, the information one must master to do well on the MCAT has little to do with being a good doctor. When I took the MCAT, I was prepared to handle organic chemistry, biology, and physics with the best of them; my reading and writing skills have always been good, and I did fine there as well. Though I scored well enough to be average at the nation's better medical schools, I am very much aware that its predictions that I would do fine on boards did not mean that I would make a good MD or DO. What the scores did undeniably mean is that I had a real chance at getting an interview to an American medical school (an option I chose not to exercise).
The ideas behind the CCAT are good ones. When I was a student, I proposed to my strategic planning team at Logan College that an MCAT was needed to screen applicants. I was told that the CCAT was coming ... and here it is today, in the form of a pilot project. I stated then, and I state today, that it is unfortunate that we are creating our own examination. Requiring the MCAT would allow us to compare directly with the medical profession in terms of academic acumen. Do we fear this comparison? The CCAT's stated goal of screening applicants for potential academic weaknesses is excellent, as it can thus be used to counter those weaknesses so that our students can pass their chiropractic boards. I think this wise, and valuable, however, I think we're missing an obvious opportunity.
My main feeling with respect to this CCAT is one of concern. Throughout my student years at Logan College, I fought (some might even say crusaded) for higher standards for our profession in terms of academics, ethics, and clinical excellence. Having a standardized entrance exam to measure our entering students' strengths and weaknesses is an excellent idea; however I am disappointed that, to quote an article in the Journal of the American Chiropractic Association (Nov. 1996, p. 79), "Students' scores on the exam will not be used in making admissions decisions..." I find this a shame. Logan was jam-packed with Canadians who couldn't get into Canada's premier chiropractic college, Canadian Memorial. Is it any wonder that chiropractic in Canada receives considerable respect? Is it any wonder that on national television, NBC's "Friends" pokes fun at the admissions standards for American chiropractors?
I believe that the CCAT should be used first as a tool to help people, but secondarily it should be used to decide, in conjunction with an interview and thoughtful consideration, who is most likely to become an asset to the chiropractic profession. No, increasing entrance requirements is not the cure-all, nor is the current attitude wherein certain chiropractic colleges build at a frantic rate to accommodate as many tuition-paying bodies as possible. The answer, as I see it, is:
- actively recruit as many people as possible to the chiropractic profession;
- select from among them those intellectually, manually, personally, and ethically capable of adding to our profession;
- provide them with the individualized classroom and clinical education necessary to become fantastic doctors.
I thank the National Board of Chiropractic Examiners for taking steps towards excellence. It is my hope that the chiropractic colleges will take this opportunity and use it wisely.
Dr. Daniel A. Shaye-Pickell
Sometimes Tongue-in-Cheek Just Isn't Funny
I was embarrassed today when a patient brought in the January 1997 issue of a magazine called Smart Money. It is the Wall Street Journal's magazine of personal business. It included the article, "Ten Things Your Chiropractor Won't Tell You." (Editor's note: see the editor's "Report of Findings" on page 3 of this issue.) At first I thought it was tongue in cheek because of the illustrations and the comical titles to each of the 10 things. Upon reading it I was amazed that in 1996 we can still see articles like this published. It was less than flattering to say the least. They even had the ignorance to refer to Ron Slaughter and the NACM quite a few times. It's a shame that this type of sensationalism is what it takes to sell magazines when more good could have been done by reporting all the research studies supporting chiropractic care.
Mark Bolinger, DC
Haddonfield, New Jersey
Solid Research 50 Years Prior to Dr. Harrison
I am writing in regards to Dr. Troyanovich's December 2, 1996 article, "The Harrison Spinal Model: a Chiropractic Lightning Rod for Criticism." I enjoyed the article very much, and I respect and appreciate the effort of anyone doing chiropractic research. However, it is because of this I must write regarding Dr. Troyanovich's comment that "for the first 90 years of the chiropractic profession's history, virtually no scientific research existed upon which to base the care and treatment of our patients."
This statement is not only untrue; it also does a huge disservice to all chiropractors. In the 1930's, 1940's and 1950's, B.J. Palmer and his research clinic staff were doing chiropractic research so advanced and state-of-the-art (such as audiometric, hematological, and metabolic changes under chiropractic care, as well as electroencephaloneurotempograph readings) that it has not even been duplicated to date. It is also my understanding that chiropractic does not provide "treatment."
Thanks for your consideration.
Steve Porter, DC
Cooperstown, New York
I am a trimester seven student at Cleveland Chiropractic College in Los Angeles, California. I am writing to share with your rearers the news about a great club that we started at our school last trimester. The name of the club is Chiropractically Speaking, and its purpose is to allow the students to practice and improve their public speaking skills.
The members of the club give a speech every two weeks on a variety of subjects ranging from chiropractic science, to chiropractic philosophy, to patient education. Each speech is up to five minutes in length and the speaker is given an evaluation by another member of the club.
The curriculum in chiropractic colleges is extremely full and unfortunately, at this time, there is no room for introducing a public speaking class. This is why I, with the greatest help from a number of other students and administrators, formed the Chiropractically Speaking club. So far, we have had approximately 20 students become active members, and we foresee a significant increase in the upcoming trimester.
As future doctors of chiropractic, one of our main responsibilities will be that of educating the public and our patients about the chiropractic profession. To become successful, it will not be enough to master the science, art, and philosophy of chiropractic, but also to be able to teach others. This can only be done if we can communicate to small or large groups of people in a professional and efficient manner. As one of our club leaders, Chris Schafer, stated, "An unspoken thought is a mental impulse. A spoken thought is a message."
Given the success that Chiropractically Speaking has had on our campus, I would like to offer any assistance to students from other colleges in starting a similar club. To find out more details about the structure and administration of the club, please call me at (310) 207-6499. I hope to hear from you soon.
Wanted: Information on Strokes and Other Emergencies
I enjoy receiving your publication and look forward to each one's arrival. The statistics that you illustrate on the lower left hand corner of the front page are especially interesting. After reading the statistics regarding complications of cervical adjusting and then the other procedures (Dec. 16, 1996 graph), I was wondering if you'd do requests.
I know that although extremely rare, strokes and other "emergency" conditions occur in chiropractors' offices from time to time. I'd like to see statistics comparing their occurrence in our offices to the occurrence while driving, or on the golf course, or at the shoe store, basically the occurrence when there is no doctor's intervention at all. I suspect that driving a car, golfing, or shopping are all just as "risky" as chiropractic adjustments, and that the incidence of stroke, heart failure, etc. is no higher in our offices that it is during the course of a person's normal day. I also suspect that these "emergencies" happen more often in dental, physical therapy, osteopathic, and of course, medical settings.
If this data is out there, it should be published, and distributed to the public. I hope DC can dig these statistics up and put them in print.
Mike Powell, DC
4245 1st Ave, SE
Cedar Rapids, IA 52402
Editor's note: The 12/16/96 issue of DC featured the article "Let's Get Rush Limbaugh Enthusiastic about Chiropractic" by Chester Wilk, DC. Although Dr. Wilk suggested that readers copy the article and send it to Mr. Limbaugh, he did not provide the address. Rush Limbaugh's address is: Rush Limbaugh, 2 Penn Plaza, New York, NY 10121. For readers who no longer have the 12/16 article, contact Dr. Wilk at 5130 W. Belmont Ave., Chicago, IL 60641, tele. (778) 725-4878.